Health Care: Back to the Drawing Board

I understand the ‘Swiss cheese’ nature of the reconciliation procedure, but here is what you left out:

If they pay for it with a progressive increase in income tax rates, they cannot strike any portion of it

There, I said it. Do it right and do it now…

BTW, FYI KT, Obama never said:

“Read my lips, no new taxes!”

That was from another era in another time…

Obama did say he would not raise taxes on people making less than $250,000.

My understanding is that Ways and Means in the House is looking at a “surcharge” on high-income people. However, the Senate seems pretty committed to the idea that any tax increase should be health-related. By the way, I’m also told that the idea of taxing sugary food is running into problems–not only from the sugar-state lawmakers, but from people who are trying to imagine what vending machines would look like if Diet Coke is one price and regular is another.

KT: Is there anything that would prohibit allowing the expiration of the Bush tax cuts to pay for it?

KT, I think you and 53 already answered some of this?, but…Is the main snag over reconciliation the financing or simply getting the Blue Dogs and Ben “Mutual of Ohama” Nelson to toe the line? Or does Reid still want Collins, Snowe, and Voinovich on board? Sorry for any repetition and pardon my cynicism. I’m shopping for new HC insurance policy and not liking it, too many moving parts and skeptical over claims….

Wow. Reid is actually showing a spine, if a vestigial one.

KT:
On reconsideration, you’re half right and I’m half right.

I think taxation is the way to go. The Senate may feel that way, but the people don’t:
http://www.cbsnews.com/stories/2009/06/19/opinion/polls/main5098517.shtml

“By two to one, Americans disapprove of taxing employer health benefits, and many are uncertain about it.”

Fourth paragraph of above article

Also–and here’s something I didn’t know until Kent Conrad told me yesterday–if they use reconciliation, they have to pay for this bill in FIVE years not TEN. If they are having this much trouble writing a bill that can balance over a decade, this would be a nightmare–and would produce at best a teensy tiny bill.

In my comment “…The Senate may feel that way…” I was referring to the taxing of health benefits.

Oops.

“Omaha” not “obama” wordplay, oops, sorry. Thanks, KT for the 5-yr update…and all of your HC reports.

KT:

I think that with the proper taxation level, the program would start off and continue to be on a sound financial footing.

The idea that it would take a certain amount of startup funds above and beyond normal operation is probably correct, but I think that is a technical issue that can be addressed fairly easily.

My feeling is that 51 votes exist, no R’s and blue dogs, but Obama can be stronger on guiding the process. The only reason taxation was not considered (excepting your comments about the surcharge) was no GOP would come on board at that point.

I think just like everything else this year, the GOP needs to be left behind. Baucus has no real power, except unless the Dems give it to him. The time has come to start laying out a bold direction change and hit the campaign trail to get the message out.

Of course, Jeb Bush, whose sage intellect is vaunted around the world, has been undecided about Obama:
http://politicalticker.blogs.cnn.com/2009/07/09/jeb-bush-i-dont-know-if-obama-is-a-socialist/

This will give him the opportunity to check ‘Yes’ in the next FOX poll.

And who cares? Do things right and do them now!

If the Senate ponders new taxes to get reconciliation, is this specific debate really going on now behind closed doors? (ha!)

non-colored link – http://www.youtube.com/watch?v=lTfdn5x7td8 (with Italian subtitles)

This be why we need single-payer, tho’ I be understandin’ tha’ be complete off th’ table.

If people an’ businesses were able t’ quit payin’ any sort o’ premium in return fer payin tha’ amount an’ progressive-applied more in taxes, wouldn’t tha’ be workin’?

I know I wouldn’a mind switchin’ th’ pot fr’m me insurance company an’ me HSA t’ th’ govt in return fer full coverage.

arrgh

An; HALLELUJAH!

Paragraph breaks be here!

ARRGH!

Thank ye, KT?
.
arrgh!

“a gaping funding hole on the order of $300 billion or so over the next 10 years.”

Current military spending is over $700 billion annually. We can’t handle a 4% mil. spending decrease per year to provide health care coverage?

deconstructiva:

Probably a pap for the GOP, I think.

Pirate Wench:

I agree with you, the public plan can be modeled after Basic Health and available to all those who have no insurance, and subsidized with higher taxes on the rich.

Some additional ideas

You can’t leave your current plan

We regulate private insurance companies

We give tax breaks to companies based on the amount they pay for employee premiums

These may not all be good ideas, but heck, with what Obama and Congress are cooking, anything is better.

Even hardtack and a lime…

What is the “problem” with Democrats and President Obama? Unlike the GOP, the Dems are actually serious about making a bipartisan solution and reaching out to a viciously ungrateful minority.

http://www.political-buzz.com/

Why do it be sayin’ thar be 19 comments, bu’ no matter wha’ I try, I only be gettin’ 15!

yarr!

I think thar be more’n one issue ‘ere wi’ health care reform – tha’ s been mentioned several times b’fore.

I’ve no problem wi’ tort reform

I’ve no problem wi’ regulatin’ insurance companies.

I’ve no problem wi’ some o’ th’ other aspects comin’ into play.

Bu’ short o’ single-payer, th’ public option be a deal-breaker fer me. If me own reps, Patty an’ Maria, an’ Rick Larsen in th’ house, don’t be active in makin’ sure tha’ option be available, I be workin’ me pirate ass off t’ be sure th’ 3 o’ em get primaried and sent back home whar they be b’longin’ if they can’t be representin’ th’ overwhelmin’ will o’ th’ th’ folks that were sendin’ ‘em to th’ other WA!

Sorry – this waterin’ down th’ rum be really gettin’ me goat!

Arrgh!

pirate: oh please, oh please, oh please write and speak to your congress reps in piratespeak. I’d love to do the same with mine in Palinspeak but I don’t think they’ll understand. You’d have a much better chance, yes?

“Why do it be sayin’ thar be 19 comments, bu’ no matter wha’ I try, I only be gettin’ 15!”

The Hideous Shebazz lady?

Better yet, Pirate wench should just sail up the Potomac and let Congress have it with a couple broadsides!

That’ll larn ‘em…

Sh!t, pirate wench, if you let me join your jolly crew, I’ll pull the lanyard!

KT, then candidate Obama ripped McCain for taxing benefits. It’s amazing how facilely this guy will change his tune.

An’ ‘ere I was all this time thinkin’ ye were already aboard wi’ th’ crew!

I be pierced, 53, ri’ t’ me soul tha’ ye weren’t knowin’ tha!

An’ deconstructiva -

I be thinkin’ tha’ if I be callin’ ‘r writin’ me reps in pirate-speak, they be disregardin’ me complete instead o’ just sighin’ an’ rollin’ their eyes an’ addin’ me t’ th’ list b’cause I be callin’ ‘em AG’IN ’bout health care reform! I be sure they be ri’ sick o’ hearin’ fr’m me…an’ th’ President, too – he be takin’ t’ task by th’ pirate wench nearly daily as I be beggin’ fer some public leadership, prod-ership, elbow-twistership, SOMETHIN t’ make th’ spineless scalliwags in th’ congress get off their fat asses an’ to th’ ri’ thing!

Ah, there I be goin’ – rantin’ ag’in!

ARRGH!

Spongy – go F yerself!

YARR!

Max is dead to me.

pirate wench

I was ashore for awhile.

Found a bottle of fortitude and passed out, missing your last call.

Hope you don’t hang me from the yardarm. I’d rather be keelhauled.

That way, at least, I’ll be able to wave goodbye to the sharks before they eat me…

Wha’ about settin’ up some sort o’ mechanism whar those who wish t’ participate in th’ public option be paying their premiums into th’ pot?

An’ open it t’ employers, too – they could be payin’ their portion into th’ same pot.

Wouldn’a tha’ lower th’ tax burden?

I be swearin’ – they be lookin’ fer an excuse t’ drop th’ public option.

An’ by th’ by – anyone see th’ autism commercial whar the kid in th’ state-regulated private insurance State be gettin’ treatment, bu’ his next-door neighbor, apparent in a diff’rent State, wi’ a “government” system be not?

Harry an’ Louise be startin’ up wi’ a vengeance – whar be th’ counter attack, me hearties?!

Arrgh!

KT,

I am going to reveal my ignorance and admit that I just don’t understand the funding issues with the health care bill. In general, I find that (virtually all) reporting on health care costs is done without providing any meaningful context.

A few thoughts:

1. One of the driving forces for health care reform is the fact that, as a nation, we vastly outspend other developed countries on health care, as a % of GDP. And yet I never see any reporting in most media stories about what affect various plans would have on total health care spending in the U.S.

2. Similarly, under our present system, many Americans are going broke paying for either health insurance or health care out of pocket. Again, reporting on various reform plans tends to downplay the net effects on Americans’ wallets. Sure taxes may go up, but if I am potentially paying $10-15k less per year in insurance, can’t I afford a modest tax increase?

3. I find sentences like “…looking for ways to fill a gaping funding hole on the order of $300 billion or so over the next 10 years.” to be totally baffling. Why is there a funding hole? How much of the hole is due to reforms and how much is due to the rising costs of existing health care obligations for the government.

4. If a public option is created, Obama has made clear it wouldn’t be subsidized. So, presumably, if it is competing fairly, the premiums should cover the expenses, right? Am I missing something? Why would a public option be a budgetary drain at all?

5. If the public option, which is currently the most controversial issue, does not play a significant factor in plugging the “gaping funding hole” shouldn’t that be made clear so that the public doesn’t get confused about which parts of the bill to support or oppose.

6. (BTW, Why are Democrats so stupid as to even talk about taxing any health care benefits? I don’t care how gold-plated they are.)

All this is a very long-winded way of asking why, if the driving force behind reform is an effort to SAVE MONEY, that I keep reading about how much this bill will COST.

Nah, me rage be consumed wi’ th’ congress, laddie, come on back aboard!

Ye can even man th’ lanyard!

arrgh!

An’ why be no one providin’ th’ context o’ what it be costin’ us NOW, and what th’ costs be expected t’ be 10 years fr’m now WI’OUT reform an’ th’ public option?

I be thinkin’ ever’ time they be mentionin’ wha’ reform be goin’ t’ cost, they ought t’ be required t’ point out th’ alternative!

arrgh!

Cross posted from JK’s thread:

One of the forces that drives the insurance debate is the knee-jerk demonization of business. It’s very easy to do, especially in light of the apparently successful lobbying efforts to prevent the current crop of insurers from losing their gravy train.

But what people fail to understand is that self-interest and greed are indeed powerful motivators and they can’t be legislated away. The trick is to design the system where amoral self-interest and high minded altruism yield identical results.

I still think a public plan is an important part of that equation but as long as it’s being sold as a come-uppance to the greedy ba$tard insurance companies it’s going to be a non starter in DC.

PW, I see you’re still you’re charming self. Of course, you cannot answer Obama’s flip-flop. Why is it nuts when McCain proposes it, but genius when the Sainted One proposes it.

you’re should be your

I’ve written about this before, but maybe it’s worth going over how this works. Under the “pay-go” rules that the Dems reinstituted when they took back control in 2006, this bill has to be deficit neutral over the next 10 years. This does not measure the effects on the costs of health care overall, but rather the effects on the costs of health care TO THE GOVERNMENT–which means we are largly talking about what it pays for medicare and medicaid, and how much it brings in in taxes. As Orszag has pointed out, you can do things that make a HUGE difference to health care costs overall, but if they don’t “score” on the government’s books, you don’t get any credit for them.

A reminder: I don’t make these rules; i just write about them.

The big-ticket costs, BTW, are providing subsidies to people who need them to buy coverage (they are talking abour providing them for those making as much as 400% of poverty) and expanding medicaid.

OT, but interesting:

http://www.city-journal.org/2009/eon0707hm.html

enjoy

A reminder: I don’t make these rules; i just write about them.

I’m trying to not be critical. I honestly get confused about this stuff.

Having said that, the Democrats created PAYGO. They created exceptions to PAYGO — including the Bush tax cuts. And they chose to not make any exceptions for the current reform legislation. That’s all well and good, but I don’t understand why those choices are simply accepted as gospel and the pros and cons of those choices are rarely addressed.

And I still feel that the large cost of paying for EXISTING obligations for the next 10 years is intentionally or accidentally being used to make reform itself appear to be costly.

Me own doubloons be on “intentionally”!

YARR!

“…people who are trying to imagine what vending machines would look like if Diet Coke is one price and regular is another.”

And you bought that? The excuse/lie I mean, not the Diet Coke.

From the article you linked to:

But the Court avoided the more basic question raised by the case: Why was the exam being discussed in terms of race and discrimination at all? The New York Times’s Supreme Court reporter, Linda Greenhouse, wrote in an op-ed that the exam “appeared to favor white test-takers.” It did nothing of the sort. It merely favored those who had studied hard and prepared themselves to become captains and lieutenants.

It sounds like the author never read the courts judgment. If he bothered to make it through to Ginsberg’s dissenting opinion, he would have found plenty of evidence that supports the notion that the test appeared to favor white test-takers. Not because of some malicious racist intent by the city, but because of institutional and economic factors such as limited access to the study material for black candidates. The majority held that the city did not provide a strong basis of evidence for their claim of liability under Title VII of the Civil Rights Act of 1964. The minority disagreed, and so do I.

I call shenanegans!

all this “pay for within X years” stuff is pure BS — all that the Dems need to do is “suspend the rules” with its 60 vote majority and it can pass whatever it wants (and limit debate) with 50 votes (since Joe Biden breaks the tie).

Karen needs to stop carrying water for the insurance companies by quoting people like Kent Conrad without informing people of how much money he’s gotten from health insuirance and for-profit health care lobbies. The health care parasite want us to think its really complicated, but it really isn’t complicated at all — and Karen and the rest of the media should stop doing stenography on behalf of these parasites.

Pretty thin gruel, Nathan.

the Dems need to do is “suspend the rules” with its 60 vote majority and it can pass whatever it want

Paygo doesn’t exist in a vacuum. It exists because the federal Treasury really Isn’t a bottomless pit and we really do need to eventaully pay down any borrowing.

The reason Republican attacks on defecit spending are so effective it because its a real problem. The reasons those attacks fall short is because it’s a real problem that the Republicans conveniently ignore whenever they’re holding the ball.

If whatever comes out can’t be self-sustaining by ten years out, then it doesn’t deserve to pass.

I honest be b’lievin’ tha’ if people were asked,

“If you could stop paying insurance premiums, co-pays, and out of pocket expenses, and instead pay the equivalent amount in taxes to be 100% covered under a government-administered health insurance plan, would you switch?”

tha’ th’ vast majority would say AYE!

Even if ye tacked on a wee bit o’ tax – progressive tax – I be b’lievin’ most would opt fer tha’ option.

Bu’ it all be in th’ framin’ o’ th’ debate, an’ tha’ question will ne’er be asked!

YARR!

“Karen needs to stop carrying water for the insurance companies…”

And Coca-Cola. Our healthcare crisis is driven directly by a lifestyle crisis and super-sized, corn-syrup laden non-foods are right at the heart of it – so to speak.

Dems weren’t running things when the Bush tax cuts passed, and reinstituting pay-go–which the GOP had abolished–was a big part of their trying to show that they were going to be more fiscally responsible. That said, you are not the only arguing they need to suspend pay-go.

Here’s a story I wrote on this:

http://www.time.com/time/politics/article/0,8599,1894939,00.html

which includes this:

So daunting is the prospect of passing a bill that fits the confines of a pay-as-you-go budget that a coalition of 30 organizations pushing for health-care reform — including the U.S. Chamber of Commerce, organized labor, the drug lobby, AARP and organizations representing hospitals, doctors and patients — wrote a letter in March asking lawmakers to suspend the rule with respect to health-care reform. But officials at both ends of Pennsylvania Avenue say that would be political suicide at a time of record deficits — and a guarantee that Republicans and fiscally conservative Democrats would not support the plan.

For the record: i drink only Diet Coke and use Splenda in my iced tea.

Amen to evils of high fructose corn syrup. High in calories for its volume. Really sucks. Plain real sugar in moderation is better.

“Even if ye tacked on a wee bit o’ tax – progressive tax – I be b’lievin’ most would opt fer tha’ option.”

And if that tax were at the level required for pay as you go, then it stands to reason that it would be budget-neutral and will thus, have the benefit of requiring only 51 votes to pass, and it cannot also be picked apart by the GOP

Run the GOP, and spob with them, the fock over!

KT:
I’m mystified by why you like Diet Coke. I crave regular Coke, but usually don’t drink it because of the sugar content.

What mystifies me is why they cannot use a different sweetener to give it the same flavor. It tastes like a chemical cocktail to me – defiantly not the same. I’ve tried to like it, but it just don’t taste right!

PD: Please see my reply to square1 on this point. Also, don’t forget, the President has promised over and over that this bill will pay for itself in 10 years.

Honestly, KT, how much is an Obama promise worth?

I’m sensitive to bitter aftertastes from AS’s (artificial sweeteners, not Amy). Do some people simply get used to it or are there genetic factors? Some chemicals / tastes and things like curling tongues are genetic. still wondering

@decon,
I’m convinced it’s genetic as well.

If I’m mistakenly served a diet cola at a drive up window, it can ruin a whole day.

Corn-syrup laden Pepsi (in very moderate amounts) and unsweetened iced tea for me. When diagnosed, my brother the diabetic was also told what his maximum daily caloric intake should be. He told the doc, “…but I drink that much (two big-gulps) before breakfast.”

Somehow, this has to stop.

Two words: Coke Zero.

I still don’t drink it, but it at least doesn’t taste like an industrial cleaner.

There is also substantial evidence that people drink double-super–mega-gulps because 8-12 oz of corn-syrup-flavored soda is not satisfying in the way that 8-12 oz of sugar-flavored soda is.

Personally, I’m enjoying Throwback Pepsi while it lasts. You can also find Latin-American imported Coke and Pepsi with sugar at your local bodega if necessary. Definitely lose the corn syrup.

KT:

Your reporting on this issue continues to lap the field, but I don’t think you get to decide what the “real news” is. I was, and am, gobsmacked by the mere concept of Harry Reid not knuckling under. Unless, of course, it’s yet another position from which to retreat when the chips are down.

“I don’t think you get to decide what the “real news” is.”

Well, she does have the big pen ;^)

For myself, I balk at the “[i]t’s not quite that simple,” meme. Obama and the Democrats in Congress have everything they need to pass a strong public option, most importantly, the backing of large majorities of the public. This is as near perfect an experiment in which interests the Democrats represent as you will probably ever find. A robust national public option, without triggers or other such industry bought obstruction, will mean it’s the public at large – us. Anything else and, well, not us.

H*ll, they be havin’ near everythin’ they need t’ be passin’ single-payer, too! ‘cept fer testicles, o’ course!

I’d like t’ see th’ public option expanded yearly t’ accomodate everyone who be wantin’ in once they be seein’ th’ difference – tha’d be tackin’ in th’ direction o’ single-payer eventual, which I be b’lievin’ be comin sooner ‘r later.

Another item tha’ don’t be gettin a lot o’ attention these weeks be th’ huge amounts o’ money bein’ spent lobbyin’ by th’ health care industry – why be no one makin’ th’ connection tha’ whilst they be denyin’ coverage t’ sick folks, they be havin’ no qualms a’tall ’bout spendin’ premiums on lobbyin’.

I’d be bettin’ thar’d be a hew an’ cry fr’m folks payin’ fer wha’ they be prayin’ be coverage should they be sick, an’ instead havin’ their money bein’ diverted fer this sort o’ sh*t! If they be made aware o’ th’ connection, tha’ be.

Oh wait – tha’d be takin’ a vigilant press – never be mindin’!

Arrgh!

PS – this be th’ cleaned up version – th’ one lackin’ th’ delicately deployed asterisks be in moderation!

“H*ll, they be havin’ near everythin’ they need t’ be passin’ single-payer, too! ‘cept fer testicles, o’ course!”

Count me among your ranks of the smitten, pirate wench.

FO:

Here’s the latest Roll Call story:

http://www.rollcall.com/news/36640-1.html

(you might need a subscription, so i’ll post the meat of the story):

The Senate Finance Committee on Thursday continued to try to reach a consensus on health care reform, with Majority Leader Harry Reid (D-Nev.) doing an about-face and saying that he supports the panel’s efforts to strike a deal.
During the weekly Senate Democratic leadership news conference, Reid voiced support for the work being done in Finance — a stark contrast from where he stood earlier in the week. On Tuesday, Reid urged Finance Chairman Max Baucus (D-Mont.) to rein in his pursuit of GOP support for a package for fear it would cost too many Democratic votes.
But on Thursday, Reid, who has long been a close ally of Baucus, was effusive in his praise for the Finance Committee’s work.
“They just had a bipartisan meeting,” Reid said in reference to the Thursday morning closed-door meeting of the full Finance Committee. “They’ve accomplished so much.” The Senate Finance Committee on Thursday continued to try to reach a consensus on health care reform, with Majority Leader Harry Reid (D-Nev.) doing an about-face and saying that he supports the panel’s efforts to strike a deal.
During the weekly Senate Democratic leadership news conference, Reid voiced support for the work being done in Finance — a stark contrast from where he stood earlier in the week. On Tuesday, Reid urged Finance Chairman Max Baucus (D-Mont.) to rein in his pursuit of GOP support for a package for fear it would cost too many Democratic votes.
But on Thursday, Reid, who has long been a close ally of Baucus, was effusive in his praise for the Finance Committee’s work.
“They just had a bipartisan meeting,” Reid said in reference to the Thursday morning closed-door meeting of the full Finance Committee. “They’ve accomplished so much.”

What happened? Maybe Roll Call overwrote the original story; maybe Reid backtracked. i’m hearing it both ways, but I saw this coming, which is why I didn’t think the original report was “real news.”

Great piece on the (link!) costs Americans seem willing to bear vs. those they do not. Or is this really an accurate reflection of American will? Do majorities support such insane spending in Iraq or Afghan and not on real health care reform?

Key quotes: “Moreover, the U.S. barely has begun to face the enormous financial bill for the war. By our accounting, the U.S. has already spent $1 trillion on operations and related defense spending, with more to come — and it will cost perhaps $2 trillion more to repay the war debt, replenish military equipment and provide care and treatment for U.S. veterans back home.”

“This wartime spending undoubtedly has been a major contributor to our present economic collapse. The U.S. has waged an expensive war as if it required little or no economic sacrifice, funding the conflict by massive borrowing. As we’ve observed in the past, you can’t spend $3 trillion on a reckless foreign war and not feel the pain at home.”

The authors: Linda J. Bilmes of Harvard University, former assistant secretary of Commerce. Joseph Stiglitz of Columbia University, winner of the Nobel Prize in economics and a former chairman of the Council of Economic Advisors. They are the co-authors of “The Three Trillion Dollar War: The True Cost of the Iraq Conflict.”

Jcapan- that article is depressing, but not-at-all surprising. Obama is making a mistake by not pushing, as hard as he can, to get all troops out of Iraq and Afghanistan (save maybe a small peace-keeping force, under local or UN authority, to monitor the void/mess we leave)- then slash spending on the development/production of new equipment.

Yes, I know, Pakistan has nukes and we don’t want the bad guys to get them. But the Taliban, for the most part, are nomads with rifles. They won’t be able to over-run the Pakistani Army. Hell, keep a small contingent of soldiers on-hand to prevent smuggling, but stop these costly wars.

Iran has no nuclear weapons program and there are UN inspectors on-site to make sure they don’t start one. There are no terrorists in Iraq, save the ones that came to fight us once we showed up. No Airforce or Navy can invade the US. The Taliban and al Qaeda are not the same. A terrorist can plan an attack on his Blackberry- fighting in the Middle East is not going to stop that, it will only add fuel to his fire. Stop spending needlessly. Stop sending our children to kill and die.

(I’m putting my soapbox away for the night and I’m gonna have my namesake)

I be havin’ t’ recuse meself fr’m discussin’ th’ sand box fer th’ foreseeable future…I were stoppin’ watchin’ th’ news as o’ last week since one o’ me progeny be headin’ o’er sometime soon, an’ things be no’ lookin’ so good. I don’t want t’ be gettin’ meself all astir b’fore things even be gettin’ started!

It be one thing t’ be a pirate wench…bu’ another all t’gether t’ be a mom w’ a “kid” headin’ into harms way…AG’IN…this be #3 fer this one.

So, discuss away, bu’ I ‘be sittin’ this one out!

Arrgh, an’ Semper Fi, me hearties!